The study included 223 patients with PAF non-valvular etiology aged 18 to 65 years (on average (58.5±5.8) years, 72 (32.3%) females, 151 (67.7%) males). PAF non-valvular genesis was recorded against the background: myocardial fibrosis in 15 (6.7%) and coronary artery disease - in 208 (95.3%) respectively. Of these, stable angina grade II existed in 39 (17.5%), grade III in 24 (10.8%), postinfarction cardiosclerosis in 17 (7.6%), stenting in 3 (1.3%), coronary artery bypass in 5 (2.2%). Hypertension was found in 190 (85.2%) people, of which stage I was 2 (0.9%), stage II in 142 (63.7%), and III in 46 (20.6%). In the 65 (21.9%) patients there was an I functional class NYHA scale of heart failure, in 111 (49.8%) - II functional class, in 47 (21.1%) - III functional class. The average heart rate for ECG data at the time of discharge from the hospital was 78.6 ± 11.1 beats / min, in 148 (66.4%) patients had strict control of heart rate, and in 75 (33.6%) - lenient. For the heart rate control the following drugs were used: bisoprolol in 171 (76.7%) patients, carvedilol in 52 (23.3%), digoxin in 81 (36.3%). A high dose of ?-adrenoblockers (BB), that is, median-therapeutic and higher, occurred in 139 (81.3%) cases with bisoprolol and in 24 (46.2%) when receiving carvedilol. Patients were divided into two groups: heart failure with preserved left ventricular ejection fraction (HFpEF) - n =159 and redused left ventricular ejection fraction (HFrEF) - n=64 according to echocardiography and subgroups according to the prescribed BB. At the time of discharge, strict control of heart rate was achieved at 34.4% with concomitant HFrEF and 63.5% with concomitant HFpEF, and lenient - in 65.6% and 36.5% of patients respectively. Possibility of achieving strict heart rate control at discharge in patients with PAF non-valvular etiology and concomitant HFrEF subcutaneously decreased with the use of carvedilol compared with bisoprolol (p=0.049) standardized by other factors. At the same time, as a consequence, the use of digoxin (p=0.03) as additional drag for heart rate control increases. In patients with PAF non-valvular etiology and concomitant HFpEF, the possibility of achieving strict heart rate control at discharge is associated with the use of high doses (mean therapeutic and higher) (p<0.001), standardized by other factors, the use of bisoprolol has no significant advantages compared with carvedilol therapy (p=0.57), but there is a dose-dependent effect (p=0.02). Than we performed prospective observation in which 30 patients with PAF non-valvular etiology were included. Duration of observation was 238.3±17.0 days, and design provided 3 visits. Titration of BB lasted 67.7±10.3 days, and the null and first visits were dissolved in time. 170.6±17.7 days, receiving the maximum or maximum tolerated dose of BB, that is interval between first and second visits. We established that during 6 months of observation in patients with PAF non-valvular aetiology usage of BB has a positive effect on LQ by decreasing the intensity of HF symptoms on the MLHFQ scale by improving physical health factor, as well as improving tolerance to physical activity due to adequate heart rate control, however, diastolic LV dysfunction is increased, violation of functioning heart valvular structures and an increase its cameras sizes due to overloading with their pressure. We proved that during semi-annual observation in patients with PAF non-valvular genesis strict heart rate control has the advantage over the lenient to improve the patients functional state as well as improving the structural and myocardial functional state, size and contraction of the right heart. We show that critical value of heart rate >91 beats/min is a predictor of negative dynamics of estimated indicators: SAS - on the scale of EHRA and SAF, physical tolerance - the index of double product (i DP), systolic dysfunction - speed systolic waves on the segments of the mitral valve (Sm) and the degree of regurgitation on the mitral valve (R MV) and can serve as a benchmark for the impossibility of achieving a strict heart rate control.
